Healthcare Provider Details

I. General information

NPI: 1427125764
Provider Name (Legal Business Name): PAUL G TERMINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MONTAGE MOUNTAIN RD # A
MOOSIC PA
18507-1707
US

IV. Provider business mailing address

340 MONTAGE MOUNTAIN RD # A
MOOSIC PA
18507-1707
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-3686
  • Fax: 570-558-6838
Mailing address:
  • Phone: 570-346-3686
  • Fax: 570-558-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD053604L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD053604L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001648057
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: